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HOME / ABOUT US / NDIS PARTICIPANT REFERRAL

NDIS Participant Intake Form

Ready to get started? Please complete our NDIS participant in-take form below and one of our staff will be in contact with you to discuss your requirements and organise the help and care you need.

 

If you still have some questions, please contact us here.

Participant Information

Aboriginal or Torres Strait Islander?

Emergency Contact / Guardian Details

Support Services Required

(select all that apply)

If your service requirement is not listed above, please share details in the comments section before submitting this form.

E.g.: Wednesday, Thursday and Friday between 9am-1pm

Participants NDIS Plan

If Plan Managed, what is your Plan Managers details:

Upload NDIS Plan
Upload supported file (Max 15MB)

Referrer Information

(If applicable)

Additional Information

E.g. disability / mental illness / medical illness / behavioural, social, emotional concerns / regular medications / allergies

E.g. behavioural, physical limitations, social, environmental

E.g. family / carer information, housing, health and development history, experience of abuse and/or neglect (including cultural abuse), protective notifications, out-of-home care history

Additional Comments

Declaration

I consent to my information being provided to BuildKare NDIS for the purposes of referral, service delivery and inclusion in de-identified data reporting.

At BuildKare NDIS, our participant intake and referral process is streamlined to ensure ease of access and efficiency for both new and existing clients. Our online form is tailored to gather all the necessary information in a single step. This system not only speeds up the referral process but also enhances accuracy and privacy, allowing participants to securely submit their details and start their journey with us without delay.


We understand the importance of a smooth transition to our services, which is why our online form ensures that all information is processed quickly and accurately. Once submitted, referrals are promptly reviewed by our team, facilitating a faster response and the seamless initiation of services tailored to each participant's needs.

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